Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.
Department of Radiology, Erasmus MC, Rotterdam, The Netherlands.
Br J Surg. 2017 Nov;104(12):1695-1703. doi: 10.1002/bjs.10594. Epub 2017 Aug 30.
Hepatocellular adenoma (HCA) is a benign liver tumour that may be complicated by bleeding or malignant transformation. Present guidelines advise cessation of oral contraceptives and surgical resection if the lesion is still larger than 5 cm at 6 months after diagnosis. The aim of this study was to evaluate whether this 6-month interval is sufficient to expect regression of a large HCA to 5 cm or smaller.
This retrospective cohort study included all patients with an HCA larger than 5 cm diagnosed between 1999 and 2015 with follow-up of at least 6 months. Medical records were reviewed for patient characteristics, clinical presentation, lesion characteristics, management and complications. Differences in characteristics were assessed between patients kept under surveillance and those who underwent treatment for an HCA larger than 5 cm.
Some 194 patients were included, of whom 192 were women. Eighty-six patients were kept under surveillance and 108 underwent HCA treatment. Patients in the surveillance group had a significantly higher BMI (P = 0·029), smaller baseline HCA diameter (P < 0·001), more centrally located lesions (P < 0·001) and were more likely to have multiple lesions (P = 0·001) than those in the treatment group. There were no significant differences in sex, age at diagnosis, symptoms, complication rates and HCA subtype distribution. Time-to-event analysis in patients managed conservatively and those still undergoing treatment more than 6 months after diagnosis showed that 69 of 118 HCAs (58·5 per cent) regressed to 5 cm or smaller after a median of 104 (95 per cent c.i. 80-128) weeks. Larger HCAs took longer to regress (P < 0·001). No complications were documented during follow-up.
This study suggests that a 6-month cut-off point for assessment of regression of HCA larger than 5 cm to no more than 5 cm is too early. As no complications were documented during follow-up, the cut-off point in women with typical, non-β-catenin-activated HCA could be prolonged to 12 months, irrespective of baseline diameter.
肝细胞腺瘤（HCA）是一种良性肝脏肿瘤，可能会发生出血或恶性转化等并发症。目前的指南建议，如果病变在诊断后 6 个月仍大于 5cm，应停止口服避孕药并进行手术切除。本研究旨在评估 6 个月的时间间隔是否足以使较大的 HCA 缩小至 5cm 或更小。
本回顾性队列研究纳入了 1999 年至 2015 年间诊断为直径大于 5cm 的 HCA 且随访时间至少 6 个月的所有患者。回顾病历以评估患者特征、临床表现、病变特征、管理和并发症。比较了接受监测和治疗的患者之间的特征差异。
共纳入 194 例患者，其中 192 例为女性。86 例患者接受监测，108 例患者接受 HCA 治疗。监测组患者的 BMI 显著更高（P=0·029），基线 HCA 直径更小（P＜0·001），病变位置更居中（P＜0·001），且更有可能存在多发病灶（P=0·001）。两组患者在性别、诊断时年龄、症状、并发症发生率和 HCA 亚型分布方面无显著差异。对接受保守治疗和诊断后 6 个月以上仍在治疗的患者进行生存时间分析显示，在中位时间 104 周（95%可信区间 80-128）后，118 个 HCA 中有 69 个（58.5%）缩小至 5cm 或更小。较大的 HCA 需要更长的时间才能缩小（P＜0·001）。随访期间未记录到并发症。
本研究表明，将直径大于 5cm 的 HCA 评估为缩小至不超过 5cm 的 6 个月截止点可能为时过早。由于随访期间未记录到并发症，对于具有典型、非β-catenin 激活特征的 HCA 患者，无论基线直径如何，截止点都可以延长至 12 个月。
